|
HC CANNULA VEIN GRAFT
|
Facility
|
OP
|
$35.19
|
|
| Hospital Charge Code |
27000096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$31.67 |
| Rate for Payer: Aetna Commercial |
$29.91
|
| Rate for Payer: Aetna Medicare |
$17.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.87
|
| Rate for Payer: BCBS Complete |
$14.08
|
| Rate for Payer: Cash Price |
$28.15
|
| Rate for Payer: Cofinity Commercial |
$24.63
|
| Rate for Payer: Cofinity Commercial |
$30.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.15
|
| Rate for Payer: Healthscope Commercial |
$31.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.91
|
| Rate for Payer: PHP Commercial |
$29.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.87
|
| Rate for Payer: Priority Health SBD |
$22.17
|
|
|
HC CANNULA VENOUS RT PVC
|
Facility
|
IP
|
$85.68
|
|
| Hospital Charge Code |
27000681
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.98 |
| Max. Negotiated Rate |
$77.11 |
| Rate for Payer: Aetna Commercial |
$72.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.69
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$59.98
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$77.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.83
|
| Rate for Payer: PHP Commercial |
$72.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: Priority Health SBD |
$53.98
|
|
|
HC CANNULA VENOUS RT PVC
|
Facility
|
OP
|
$85.68
|
|
| Hospital Charge Code |
27000681
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$77.11 |
| Rate for Payer: Aetna Commercial |
$72.83
|
| Rate for Payer: Aetna Medicare |
$42.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.69
|
| Rate for Payer: BCBS Complete |
$34.27
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$59.98
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$77.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.83
|
| Rate for Payer: PHP Commercial |
$72.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: Priority Health SBD |
$53.98
|
|
|
HC CANNULA VEN SINGLE STAGE
|
Facility
|
OP
|
$73.44
|
|
| Hospital Charge Code |
27000263
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.38 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$36.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: BCBS Complete |
$29.38
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health SBD |
$46.27
|
|
|
HC CANNULA VEN SINGLE STAGE
|
Facility
|
IP
|
$73.44
|
|
| Hospital Charge Code |
27000263
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.27 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health SBD |
$46.27
|
|
|
HC CANNULA VEN SNGL STG RT ANG
|
Facility
|
IP
|
$97.92
|
|
| Hospital Charge Code |
27000267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.69 |
| Max. Negotiated Rate |
$88.13 |
| Rate for Payer: Aetna Commercial |
$83.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.65
|
| Rate for Payer: Cash Price |
$78.34
|
| Rate for Payer: Cofinity Commercial |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$84.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.34
|
| Rate for Payer: Healthscope Commercial |
$88.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.23
|
| Rate for Payer: PHP Commercial |
$83.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.65
|
| Rate for Payer: Priority Health SBD |
$61.69
|
|
|
HC CANNULA VEN SNGL STG RT ANG
|
Facility
|
OP
|
$97.92
|
|
| Hospital Charge Code |
27000267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.17 |
| Max. Negotiated Rate |
$88.13 |
| Rate for Payer: Aetna Commercial |
$83.23
|
| Rate for Payer: Aetna Medicare |
$48.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.65
|
| Rate for Payer: BCBS Complete |
$39.17
|
| Rate for Payer: Cash Price |
$78.34
|
| Rate for Payer: Cofinity Commercial |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$84.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.34
|
| Rate for Payer: Healthscope Commercial |
$88.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.23
|
| Rate for Payer: PHP Commercial |
$83.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.65
|
| Rate for Payer: Priority Health SBD |
$61.69
|
|
|
HC CANNULA VEN TRIPLE STAGE
|
Facility
|
IP
|
$73.44
|
|
| Hospital Charge Code |
27000035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.27 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health SBD |
$46.27
|
|
|
HC CANNULA VEN TRIPLE STAGE
|
Facility
|
OP
|
$73.44
|
|
| Hospital Charge Code |
27000035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.38 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$36.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: BCBS Complete |
$29.38
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health SBD |
$46.27
|
|
|
HC CARB 10,11 EPXID
|
Facility
|
OP
|
$44.76
|
|
|
Service Code
|
CPT 80161
|
| Hospital Charge Code |
30100742
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$40.28 |
| Rate for Payer: Aetna Commercial |
$38.05
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$16.50
|
| Rate for Payer: BCN Commercial |
$16.50
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$35.81
|
| Rate for Payer: Cash Price |
$35.81
|
| Rate for Payer: Cofinity Commercial |
$38.49
|
| Rate for Payer: Cofinity Commercial |
$31.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$40.28
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.05
|
| Rate for Payer: Nomi Health Commercial |
$27.96
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$38.05
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.64
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$14.91
|
| Rate for Payer: Priority Health SBD |
$28.20
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$10.49
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC CARB 10,11 EPXID
|
Facility
|
IP
|
$44.76
|
|
|
Service Code
|
CPT 80161
|
| Hospital Charge Code |
30100742
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$40.28 |
| Rate for Payer: Aetna Commercial |
$38.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.09
|
| Rate for Payer: Cash Price |
$35.81
|
| Rate for Payer: Cofinity Commercial |
$31.33
|
| Rate for Payer: Cofinity Commercial |
$38.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.81
|
| Rate for Payer: Healthscope Commercial |
$40.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.05
|
| Rate for Payer: PHP Commercial |
$38.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.09
|
| Rate for Payer: Priority Health SBD |
$28.20
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100022
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.76
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$32.05
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health SBD |
$28.84
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100022
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna Medicare |
$15.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.21
|
| Rate for Payer: BCBS Complete |
$8.20
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$12.90
|
| Rate for Payer: BCN Commercial |
$12.90
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Cofinity Commercial |
$32.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Mclaren Medicaid |
$7.81
|
| Rate for Payer: Mclaren Medicare |
$14.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.30
|
| Rate for Payer: Meridian Medicaid |
$8.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$21.86
|
| Rate for Payer: PACE Medicare |
$13.84
|
| Rate for Payer: PACE SWMI |
$14.57
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: PHP Medicare Advantage |
$14.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.99
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health Narrow Network |
$11.99
|
| Rate for Payer: Priority Health SBD |
$28.84
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.57
|
| Rate for Payer: UHC Medicare Advantage |
$14.57
|
| Rate for Payer: UHCCP Medicaid |
$8.20
|
| Rate for Payer: VA VA |
$14.57
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE CMPT
|
Facility
|
OP
|
$44.74
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100060
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$16.50
|
| Rate for Payer: BCN Commercial |
$16.50
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Nomi Health Commercial |
$27.96
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.08
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$28.19
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$10.49
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE CMPT
|
Facility
|
IP
|
$44.74
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100060
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.19 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.08
|
| Rate for Payer: Priority Health SBD |
$28.19
|
|
|
HC CARBON DIOXIDE (BICARB)
|
Facility
|
IP
|
$21.64
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna Commercial |
$18.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.07
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: PHP Commercial |
$18.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: Priority Health SBD |
$13.63
|
|
|
HC CARBON DIOXIDE (BICARB)
|
Facility
|
OP
|
$21.64
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$213.07 |
| Rate for Payer: Aetna Commercial |
$18.39
|
| Rate for Payer: Aetna Medicare |
$5.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.10
|
| Rate for Payer: BCBS Complete |
$2.75
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCN Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Mclaren Medicaid |
$2.62
|
| Rate for Payer: Mclaren Medicare |
$4.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.12
|
| Rate for Payer: Meridian Medicaid |
$2.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Nomi Health Commercial |
$7.32
|
| Rate for Payer: PACE Medicare |
$4.64
|
| Rate for Payer: PACE SWMI |
$4.88
|
| Rate for Payer: PHP Commercial |
$18.39
|
| Rate for Payer: PHP Medicare Advantage |
$4.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.03
|
| Rate for Payer: Priority Health Medicare |
$4.88
|
| Rate for Payer: Priority Health Narrow Network |
$4.02
|
| Rate for Payer: Priority Health SBD |
$13.63
|
| Rate for Payer: Railroad Medicare Medicare |
$4.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.86
|
| Rate for Payer: UHC Core |
$213.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.88
|
| Rate for Payer: UHC Exchange |
$213.07
|
| Rate for Payer: UHC Medicare Advantage |
$4.88
|
| Rate for Payer: UHCCP Medicaid |
$2.75
|
| Rate for Payer: VA VA |
$4.88
|
|
|
HC CARBOXYHEMOGLOBIN
|
Facility
|
IP
|
$78.45
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
30100134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$70.60 |
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$54.92
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Healthscope Commercial |
$70.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.99
|
| Rate for Payer: Priority Health SBD |
$49.42
|
|
|
HC CARBOXYHEMOGLOBIN
|
Facility
|
OP
|
$78.45
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
30100134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$2,552.14 |
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: Aetna Medicare |
$12.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.40
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: BCBS MAPPO |
$12.32
|
| Rate for Payer: BCBS Trust/PPO |
$10.91
|
| Rate for Payer: BCN Commercial |
$10.91
|
| Rate for Payer: BCN Medicare Advantage |
$12.32
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$54.92
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.32
|
| Rate for Payer: Healthscope Commercial |
$70.60
|
| Rate for Payer: Mclaren Medicaid |
$6.60
|
| Rate for Payer: Mclaren Medicare |
$12.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.94
|
| Rate for Payer: Meridian Medicaid |
$6.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$18.48
|
| Rate for Payer: PACE Medicare |
$11.70
|
| Rate for Payer: PACE SWMI |
$12.32
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: PHP Medicare Advantage |
$12.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.68
|
| Rate for Payer: Priority Health Medicare |
$12.32
|
| Rate for Payer: Priority Health Narrow Network |
$10.14
|
| Rate for Payer: Priority Health SBD |
$49.42
|
| Rate for Payer: Railroad Medicare Medicare |
$12.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.78
|
| Rate for Payer: UHC Core |
$2,552.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.32
|
| Rate for Payer: UHC Exchange |
$2,552.14
|
| Rate for Payer: UHC Medicare Advantage |
$12.32
|
| Rate for Payer: UHCCP Medicaid |
$6.94
|
| Rate for Payer: VA VA |
$12.32
|
|
|
HC CARDIAC REH OP PH 2 WO MONITOR
|
Facility
|
IP
|
$197.91
|
|
|
Service Code
|
CPT 93797
|
| Hospital Charge Code |
94300007
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$124.68 |
| Max. Negotiated Rate |
$178.12 |
| Rate for Payer: Aetna Commercial |
$168.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.64
|
| Rate for Payer: Cash Price |
$158.33
|
| Rate for Payer: Cofinity Commercial |
$138.54
|
| Rate for Payer: Cofinity Commercial |
$170.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.33
|
| Rate for Payer: Healthscope Commercial |
$178.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.22
|
| Rate for Payer: PHP Commercial |
$168.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.64
|
| Rate for Payer: Priority Health SBD |
$124.68
|
|
|
HC CARDIAC REH OP PH 2 WO MONITOR
|
Facility
|
OP
|
$197.91
|
|
|
Service Code
|
CPT 93797
|
| Hospital Charge Code |
94300007
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$387.72 |
| Rate for Payer: Aetna Commercial |
$168.22
|
| Rate for Payer: Aetna Medicare |
$128.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.20
|
| Rate for Payer: BCBS Complete |
$69.43
|
| Rate for Payer: BCBS MAPPO |
$123.36
|
| Rate for Payer: BCBS Trust/PPO |
$47.24
|
| Rate for Payer: BCN Commercial |
$47.24
|
| Rate for Payer: BCN Medicare Advantage |
$123.36
|
| Rate for Payer: Cash Price |
$158.33
|
| Rate for Payer: Cash Price |
$158.33
|
| Rate for Payer: Cofinity Commercial |
$170.20
|
| Rate for Payer: Cofinity Commercial |
$138.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.36
|
| Rate for Payer: Healthscope Commercial |
$178.12
|
| Rate for Payer: Mclaren Medicaid |
$66.12
|
| Rate for Payer: Mclaren Medicare |
$123.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.53
|
| Rate for Payer: Meridian Medicaid |
$69.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.22
|
| Rate for Payer: Nomi Health Commercial |
$370.08
|
| Rate for Payer: PACE Medicare |
$117.19
|
| Rate for Payer: PACE SWMI |
$123.36
|
| Rate for Payer: PHP Commercial |
$168.22
|
| Rate for Payer: PHP Medicare Advantage |
$123.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.72
|
| Rate for Payer: Priority Health Medicare |
$123.36
|
| Rate for Payer: Priority Health Narrow Network |
$310.18
|
| Rate for Payer: Priority Health SBD |
$124.68
|
| Rate for Payer: Railroad Medicare Medicare |
$123.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.36
|
| Rate for Payer: UHC Exchange |
$146.45
|
| Rate for Payer: UHC Medicare Advantage |
$123.36
|
| Rate for Payer: UHCCP Medicaid |
$69.45
|
| Rate for Payer: VA VA |
$123.36
|
|
|
HC CARDIOLIPIN AB IGA
|
Facility
|
OP
|
$51.17
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200146
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$46.05 |
| Rate for Payer: Aetna Commercial |
$43.49
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: BCBS Complete |
$14.32
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$22.53
|
| Rate for Payer: BCN Commercial |
$22.53
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Cofinity Commercial |
$35.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$46.05
|
| Rate for Payer: Mclaren Medicaid |
$13.64
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: Meridian Medicaid |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.49
|
| Rate for Payer: Nomi Health Commercial |
$38.18
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$43.49
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.45
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health Narrow Network |
$20.36
|
| Rate for Payer: Priority Health SBD |
$32.24
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.45
|
| Rate for Payer: UHC Medicare Advantage |
$25.45
|
| Rate for Payer: UHCCP Medicaid |
$14.33
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC CARDIOLIPIN AB IGA
|
Facility
|
IP
|
$51.17
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200146
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.24 |
| Max. Negotiated Rate |
$46.05 |
| Rate for Payer: Aetna Commercial |
$43.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.26
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cofinity Commercial |
$35.82
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.94
|
| Rate for Payer: Healthscope Commercial |
$46.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.49
|
| Rate for Payer: PHP Commercial |
$43.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.26
|
| Rate for Payer: Priority Health SBD |
$32.24
|
|
|
HC CARDIOLIPIN AB IGG
|
Facility
|
OP
|
$51.17
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200144
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$46.05 |
| Rate for Payer: Aetna Commercial |
$43.49
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: BCBS Complete |
$14.32
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$22.53
|
| Rate for Payer: BCN Commercial |
$22.53
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Cofinity Commercial |
$35.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$46.05
|
| Rate for Payer: Mclaren Medicaid |
$13.64
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: Meridian Medicaid |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.49
|
| Rate for Payer: Nomi Health Commercial |
$38.18
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$43.49
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.45
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health Narrow Network |
$20.36
|
| Rate for Payer: Priority Health SBD |
$32.24
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.45
|
| Rate for Payer: UHC Medicare Advantage |
$25.45
|
| Rate for Payer: UHCCP Medicaid |
$14.33
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC CARDIOLIPIN AB IGG
|
Facility
|
IP
|
$51.17
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200144
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.24 |
| Max. Negotiated Rate |
$46.05 |
| Rate for Payer: Aetna Commercial |
$43.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.26
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cofinity Commercial |
$35.82
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.94
|
| Rate for Payer: Healthscope Commercial |
$46.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.49
|
| Rate for Payer: PHP Commercial |
$43.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.26
|
| Rate for Payer: Priority Health SBD |
$32.24
|
|
